Pelvic Pains Flashcards by Briana Echols

Dysmenorrhea

painful periods

How well did you know this?

Not at all

Perfectly

Dyspareunia

pain with sex

How well did you know this?

Not at all

Perfectly

Vulvadynia

pain of the vulva

How well did you know this?

Not at all

Perfectly

Dyschezia

pain with bowel movements

How well did you know this?

Not at all

Perfectly

Dysuria

pain with urination

How well did you know this?

Not at all

Perfectly

Chronic pelvic pain

pelvic pain that has been present for > 6mo

How well did you know this?

Not at all

Perfectly

When you think cyclic pain….

fibroids, endometriosis, adenomyosis

How well did you know this?

Not at all

Perfectly

All lower abdominal pain warrants

a pelvic exam

How well did you know this?

Not at all

Perfectly

1st test for evaluating pelvic pain?

Sonogram

How well did you know this?

Not at all

Perfectly

What can a sonogram show us?

fibroids, infected (dilated) tubes, adnexal masses, blood in the abdomen

How well did you know this?

Not at all

Perfectly

How is endometriosis diagnosed?

laparoscopy

How well did you know this?

Not at all

Perfectly

What is usually a surgical emergency in ovarian masses?

6-10cm, ovarian torsion

How well did you know this?

Not at all

Perfectly

boggy enlgarged tender uterus, progressively worsening painful and heavy periods, which gets better after two weeks

adenomyosis

How well did you know this?

Not at all

Perfectly

What is adenomyosis?

extension of endometrial glands and stroma into the uterine muscle more than 2.5mm beneath the basalis layer

How well did you know this?

Not at all

Perfectly

What is seen on a cut section in adenomyosis

not distinct margin between the adenomyoma and surrounding myometrium

How well did you know this?

Not at all

Perfectly

How is adenomyosis diagnosed?

ultrasound and MRI (better, but cost more)

How well did you know this?

Not at all

Perfectly

Conformational diagnosis of adenomyosis?

surgical, usually after a hysterectomy

How well did you know this?

Not at all

Perfectly

What are leiomyomas

fibroids, benign, derived from smooth muscle cells of the myometrium

How well did you know this?

Not at all

Perfectly

What is the most common uterine neoplasia, but has minimal chance for malignant transformation?

leiomyomas

How well did you know this?

Not at all

Perfectly

Symptoms of leiomyomas?

most no symptoms

How well did you know this?

Not at all

Perfectly

Large leiomyomas produce what type of symptoms

urinary symptoms or back pain, dysmenorrhea

How well did you know this?

Not at all

Perfectly

Heavy or long periods are caused by what type of leiomyomas?

submucosal fibroid (even if small) or multiple intramural fibroids

How well did you know this?

Not at all

Perfectly

What type of leiomyomas doesn’t likely cause heavy or long periods?

subserosal or pedunculated

How well did you know this?

Not at all

Perfectly

Treatment for leiomyomas

OCPs or Progesterone
GNRH agonist (temporary)
Myomectomy (to reserve fertility)
Hysterectomy
Uterine fibroid embolization

How well did you know this?

Not at all

Perfectly

What is a functional cyst?

a follicle of at least 3cm | mobile, unilateral, and not associated w/ ascites

Symptoms of a functional cyst?

pelvic pain dull sensation heaviness in the pelvis

How is a functional cyst diagnosed?

when a 5-8cm cystic adnexal mass is noted on bimanual exam

How is a functional cyst confirmed?

lesion regresses over the course of the next several cycles

What is the treatment for a functional cyst?

OCP (low dose) to prevent another cyst

Huge size ovary, taking up the pelvis and abdomen

Mucionous Cystadenoma

Mucinous neoplasms are often..

benign tumors, multilocular and less than 10% bilateral

Benign cystic teratoma?

dermoid cyst

What is the most common ovarian neoplasm?

dermoid cyst

Dermoid cyst are mostly composed of what?

ectodermal tissue that has.. sweat and sebaceous glands, hair follicles, teeth

What age is likely to have a dermoid cyst?

25 and 50 yrs of age

How big can a dermoid cyst get?

less than 10 cm in diameter

Treatment for a symptomatic or large dermoid cyst?

surgical treatment (cystectomy vs. oophectomy)

During treatment of a dermoid cyst what must be done?

the other ovary must be examined

Most benign tumors of the fallopian tubes are

infectious or inflammatory (hydrosalpinx & pyosalpinx)

How is a tubal neoplasm and a adnexal masses differentiated on exam?

operative exploration

How is hydrosalpinx treated?

Salpingectomy

To be a functional ovarian cyst it must be at least?

3 cm

When should a cyst be referred to a gynecologist?

cyst persist after 6 weeks or more patient is symptomatic patient has a large cyst 10cm ovarian torsion cannot be ruled out

What is ovarian torsion?

complete or partial rotation of the ovary on its ligamentous support

What is often seen in ovarian torsion?

impedance of its blood supply

The most common gynecologic emergencies affecting females of all ages

Ovarian Torsion

What is the most likely factor to predispose ovarian torsion?

ovarian functional cyst

In ovarian torsion what does the ovary rotate around?

infundibulopelvic ligament and | utero-ovarian ligament

As the size of the ovarian mass increases, the risk of torsion increases, until it becomes fixed in place at ....

5 cm or larger

What causes the emergency in ovarian torsion?

loss ovarian function and necrosis

Presentation of ovarian torsion?

acute onset of moderate to severe pelvic pain w/ n/v

What does physical exam show in ovarian torsion?

consistent w/ tenderness to palpation (guarding, rebound)

What imaging is used for ovarian torsion?

TVUS (lack of color blood flow)

What is the treatment for a asymptotic or small cyst?

expectant management | observe (w/ no symptoms or pain)

Cyst that develops in association w/ a high level of hCG

Theca-Lutein Cysts

Ovarian Hyperstimulation Syndrome and theca-lutein cysts can be caused by?

a pt undergoing ovulation induction w/ gonadotropins or clomiphene

Hydatidiform mole or choriocarcinoma may develop

theca-lutein cysts

What is the treatment for theca-luthein cyst

discontinuation of medication as well as IV fluids and correction of electrolites

Describe Theca-lutein cysts?

usually bilateral quite large > 30cm regress slowly after gonadotropin level falls

Treatment for a molar pregnancy?

evacuation of uterine contents | Dilation and Curettage (D&C)

T/F Theca Lutein cysts, once source of pregnancy hormone is removed, cysts will regress

TRUE

What occurs due to a elevated BHCG hormone?

Theca-Luthein cysts

T/F if pregnancy test is negative patient should not have a theca luthein cyst?

True

Ruptured ovarian cyst is also referred as?

mittelschmerz

Ruptured ovarian cyst is likely to occur in what women?

reproductive age and postmenopausal

What is a risk factor for ovarian cyst rupture?

Vaginal intercourse

What are methods to prevent rupture of a cyst?

NONE...except: | surgical drainage or removal of the cyst

T/F Prevention of cyst rupture is a surgical indication

FALSE

What treatments can suppress ovulation and prevent the development of a new cyst

OCP

What is a classic presentation of a ruptured ovarian cyst?

sudden onset of severe sharp and focal unilateral lower quadrant pain, following sex and exercise

Which ovary is most commonly ruptured?

Right

What usually causes the pain due to a ruptured ovarian cyst

blood in the peritoneal cavity

What do the vital signs in ovarian ruptured cyst look like?

normal, low grade fever

What do the abdominal exam look like in ruptured ovarian cyst?

one side of the lower abdomen is tender | or rebound tenderness and over peritonitis

What do the pelvic exam look like in ruptured ovarian cyst?

if not completely collapsed a adnexal mass may be palpable on bimanual exam cervical motion tenderness

What do labs look like in ruptured ovarian cyst?

a low hematocrit may be caused by hemorrhage

What imaging is used to detect a ruptured ovarian cyst?

pelvic ultrasound

What does a complicated ruptured ovarian cyst look like?

signs of hemodynamic instability, hypotension, tachycardia

Treatment for a uncomplicated ruptured ovarian cyst?

observation

Treatment for a complicated ruptured ovarian cyst?

inpatient observation or surgery